Fewer complications result from a video-assisted approach to anatomic resection of clinical stage I lung cancer

Objectives: Anatomic resection is currently the standard of care for clinical stage I lung cancer, yet clinicians increasingly pursue nonsurgical, ablative therapies to avoid the morbidity of thoracotomy. The video-assisted thoracic surgery (VATS) approach is a minimally invasive alternative to thoracotomy yet the effect of VATS on the morbidity of patients undergoing lung cancer resection is not fully characterized. We evaluated complications following anatomic resection of clinical stage I lung cancer by VATS and thoracotomy to clarify the effect of the minimally invasive approach. Methods: The Society of Thoracic Surgeons database was queried for lobectomies and segmentectomies performed between 2001 and 2010 for clinical stage I primary cancer. Results: A total of 11,531 (7137 open and 4394 VATS) patients with clinical stage I primary lung cancers underwent resection. Propensity scoring was used to match cases into 2745 well-balanced pairs. Overall complications were significantly more likely in the thoracotomy group (36%) than in the VATS cohort (30%; P < .001). Patients undergoing thoracotomy experienced significantly more pulmonary complications (21% vs 18%), atrial arrhythmias (13% vs 10%), and were more likely to undergo transfusion (6% vs 4%). Operative mortality was similar (thoracotomy 1.8%, VATS 1.3%; P = .13). Conclusions: Anatomic resection of early stage lung cancer is performed with a low mortality rate, according to data from the Society of Thoracic Surgeons database. Perioperative complications are significantly less likely to occur when patients with stage I lung cancers undergo resection using the VATS approach. Further study is warranted to determine long-term effects of these differences in perioperative outcomes.